Content-type: text/html

<html>
<head>
<title>TEST</title>
<script type="text/javascript"><!-- hide from old browsers
function validate (form) {
    var alertstr = '';
    var invalid  = 0;
    var invalid_fields = new Array();

    // hostname: standard text, hidden, password, or textarea box
    var hostname = form.elements['hostname'].value;
    if (hostname == null || ! hostname.match(/^[a-zA-Z0-9][-a-zA-Z0-9]*$/)) {
        alertstr += '- Invalid entry for the "Hostname" field\n';
        invalid++;
        invalid_fields.push('hostname');
    }
    // domain: standard text, hidden, password, or textarea box
    var domain = form.elements['domain'].value;
    if (domain == null || ! domain.match(/^[a-zA-Z0-9][-a-zA-Z0-9\.]*\.[a-zA-Z]+$/)) {
        alertstr += '- Invalid entry for the "Domain" field\n';
        invalid++;
        invalid_fields.push('domain');
    }
    if (invalid > 0 || alertstr != '') {
        if (! invalid) invalid = 'The following';   // catch for programmer error
        alert(''+invalid+' error(s) were encountered with your submission:'+'\n\n'
                +alertstr+'\n'+'Please correct these fields and try again.');
        return false;
    }
    return true;  // all checked ok
}
//-->
</script>
</head>
<body bgcolor="white">
<h3>TEST</h3>
<noscript><font color="#cc0000"><b>Please enable Javascript or use a newer browser.</b></font></noscript>
<p>Fields that are <b>highlighted</b> are required.</p>
<form action="TEST" method="get" onsubmit="return validate(this);">
<div><input id="_submitted" name="_submitted" type="hidden" value="1" /></div>
<div><input id="user" name="user" type="hidden" value="pete" />
<input id="ticket" name="ticket" type="hidden" value="111" /></div>
<table>
<tr valign="top">
  <td><b>Hostname</b></td>
  <td><input id="hostname" name="hostname" type="text" value="localhost" /></td>
</tr>
<tr valign="top">
  <td><b>Domain</b></td>
  <td><input id="domain" name="domain" type="text" value="localdomain" /></td>
</tr>
<tr valign="top">
  <td align="center" colspan="2"><input id="_submit" name="_submit" type="submit" value="Submit" /></td>
</tr>
</table>
</form>
</body>
</html>
